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AnemiaNCT04622449

Etiopathogenesis of Anemia in Chronic Liver Disease

An observational study of Anemia and Chronic Liver Disease, run by Post Graduate Institute of Medical Education and Research, Chandigarh at 1 site in India.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Anemia is the most common complication of liver cirrhosis and is seen in 75% of cases. The etiology of anemia in liver disease is diverse and often multi-factorial. Given the diverse and sometimes multifactorial etiology of cirrhosis, it is difficult to determine the exact cause of anemia in these groups of patients. Read more about this study

Who is it for?
Ages 18 to 75 years
Conditions the study is for
Anemia, Chronic Liver Disease
How many people
125 participants
Where
1 siteIndia
Study dates
1 Sep 2020to 31 Dec 2021
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: All patients with chronic liver disease attending outpatient department of hepatology, admitted under hepatology department or emergency services

Who may be able to join

  • Age 18-75 years
  • Either gender
  • Patients with chronic liver disease with anemia (Hemoglobin in Non-pregnant women (18 years of age and above) <12g/dl and in men <13g/dl

Who cannot join

  • Those who do not consent to participate in the study
  • Renal dysfunction (S. Creatinine ≥ 2mg/dL)
  • Pregnancy/Lactation
  • Post liver transplant patients
  • HIV infection
  • Patients who are on psychoactive drugs, like sedatives or antidepressants
Show all 10Show fewer
  • Patients with uncontrolled sepsis
  • Patients who are too sick to carry out the protocol
  • Patients with ongoing active bleeding
  • Patients with known primary hematological disorders

Trial locations and contacts

1 site in 1 country.

Madhumita Premkumar, MD, DM contact

+9101722756344

drmadhumitap1@gmail.com

Arnav Aggarwal, MD contact

+918527459774

arnav272@gmail.com

India1 site, 1 recruiting
  • PGIMER

    Chandigarh, 160012

    Madhumita Premkumar, MD, DM, +9101722756344, drmadhumitap1@gmail.com

    Arnav Aggarwal, MD, +918527459774, arnav272@gmail.com

    Recruiting

Other trials in India

About this study

Official title: Assessment of Role of Iron Metabolism, Nutritional Deficiency, Gastrointestinal Loss, and Chronic Inflammation in the Etiopathogenesis of Anemia in Chronic Liver Disease

Anemia is the most common complication of liver cirrhosis and is seen in 75% of cases. The etiology of anemia in liver disease is diverse and often multi-factorial. Given the diverse and sometimes multifactorial etiology of cirrhosis, it is difficult to determine the exact cause of anemia in these groups of patients. The most common type of anemia encountered in liver cirrhosis is normocytic normochromic anemia, attributable to the chronic inflammatory state. The key question in management of anemia in patients with liver disease which specific factor needs to be corrected to restore hemoglobin levels and improve overall clinical status and improve severity scores.

Read the detailed description

Common causes of anemia include acute and chronic blood loss due to upper gastrointestinal (GI) bleeding, malnutrition, hemolysis, hypersplenism secondary to portal hypertension, and impaired coagulation. Alcohol causes anemia by its direct bone marrow toxicity, vitamin B12 and folate deficiency due to poor oral intake, and intestinal malabsorption. Treatment related anemia is seen in patients with chronic hepatitis C virus infection receiving ribavirin and interferon. Hepatitis associated aplastic anemia, characterized by pancytopenia and hypocellular bone marrow, is an entity seen concurrently with or within 6 months of infection with hepatotropic viruses such as hepatitis B, hepatitis C and Epstein-Barr virus. Acute and chronic blood loss from varices, portal hypertensive gastropathy and gastric antral vascular ectasia can give rise to iron-deficiency anemia, in which the picture is one of microcytic hypochromic anemia. Another common hematological abnormality seen in liver cirrhosis is macrocytosis. The causes of macrocytosis in liver cirrhosis are also multi factorial. Vitamin B12 and folate deficiency is also frequently seen in liver cirrhosis, particularly of alcoholic origin, due to malnutrition and increased intestinal permeability, and gut dysbiosis.

Patients with cirrhosis patients have a high incidence of sepsis which can trigger decompensation and may result in prolonged hospital stay and increased mortality. Many studies have estimated that about 30%-50% admissions of patients with cirrhosis have sepsis. Of those who don't have sepsis at presentation, about 15% patients admitted to hospital develop sepsis during the hospital stay. After infection develops, the patient may develop acute kidney injury (AKI), shock, encephalopathy or disseminated intravascular coagulation (DIC) further decreasing the chances of survival. Sepsis and the associated cytokines have a myelosuppressive effect and prevent the erythron from making blood cells. This results in an increase in ferritin as an inflammatory biomarker and alters iron metabolism by affecting the production of hepcidin in the liver. The worsening of anemia in patients with sepsis is well documented, and this is further impacted using drugs like antibiotics which trigger inflammation mediated suppression of the erythron and other hematopoietic precursors like megakaryocytes and leucoblasts.

In the study, after taking informed consent, participants will be evaluated for etiology of chronic liver disease with proper history, clinical examination and investigations which will include viral markers (HbsAg, Anti-HCV, Total anti-Hbc, AIH markers (Anti-nuclear antibody/ anti-smooth muscle antibody/anti- liver kidney microsomal antibody), serum ceruloplasmin, non-alcoholic fatty liver disease (NAFLD) work up and radiological investigations for cirrhosis. The severity of cirrhosis will be determined by Child-Pugh's and MELD/MELD-Na score.

To evaluate for anemia, following results would be noted: Complete hemogram with RBC indices, reticulocyte count and peripheral blood smear, RFT, LFT, INR, iron studies - serum iron, ferritin, total iron binding capacity and %transferrin saturation, serum vitamin B12, folate levels. Workup for hemolysis would include lactate dehydrogenase, serum haptoglobin, direct coombs test and plasma hemoglobin. Upper GI endoscopy findings will also be noted to evaluate the contribution of gastrointestinal blood loss in causing anemia.

Keywords
Gastro Intestinal Bleeding, Iron Deficiency Anemia, Cirrhosis, Anemia of Chronic disease, Nutritional deficiency
Medical subject headings
Anemia, Gastrointestinal Hemorrhage, Anemia, Iron-Deficiency, Fibrosis, Malnutrition

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

Study groups in NCT04622449
Study groupRoleWhat they receive
Chronic liver disease with anemiaAll patients with anemia as diagnosed by WHO criteria in patients with liver disease of any etiology.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Etiologies of anemia in patients with liver disease

    Determine the prevalence of various etiologies of anemia in patients with liver disease

    Measured: 1 month

  2. Correlation with liver disease severity

    Association of liver disease severity as measured by MELD, MELD Na and CTP scores with severity of anemia

    Measured: 1 month

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted10 Nov 2020
  2. Study start1 Sep 2020
  3. Primary completion30 Dec 2021 (estimated)
  4. Study completion31 Dec 2021 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Case only
Time perspective
Prospective
Enrolment
125 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04622449
Sponsor's protocol ID
IM/2020/1624
Status last verified
Sep 2021
First submitted
4 Nov 2020
Last updated
28 Sep 2021
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Gonzalez-Casas R, Jones EA, Moreno-Otero R. Spectrum of anemia associated with chronic liver disease. World J Gastroenterol. 2009 Oct 7;15(37):4653-8. doi: 10.3748/wjg.15.4653.

    PubMed 19787828
  • Premkumar M, Saxena P, Rangegowda D, Baweja S, Mirza R, Jain P, Bhatia P, Kumar G, Bihari C, Kalal C, Vyas T, Choudhury A, Sarin SK. Coagulation failure is associated with bleeding events and clinical outcome during systemic inflammatory response and sepsis in acute-on-chronic liver failure: An observational cohort study. Liver Int. 2019 Apr;39(4):694-704. doi: 10.1111/liv.14034. Epub 2019 Feb 7.

    PubMed 30589495
  • Nahon P, Nuraldeen R, Rufat P, Sutton A, Trautwein C, Strnad P. In alcoholic cirrhosis, low-serum hepcidin levels associate with poor long-term survival. Liver Int. 2016 Feb;36(2):185-8. doi: 10.1111/liv.13007. Epub 2015 Dec 6.

    PubMed 26561367
  • Mathurin SA, Aguero AP, Dascani NA, Prestera JA, Gianserra C, Londero E, Chiorra C. [Anemia in hospitalized patients with cirrhosis: prevalence, clinical relevance and predictive factors]. Acta Gastroenterol Latinoam. 2009 Jun;39(2):103-11. Spanish.

    PubMed 19663083
  • Stein J, Connor S, Virgin G, Ong DE, Pereyra L. Anemia and iron deficiency in gastrointestinal and liver conditions. World J Gastroenterol. 2016 Sep 21;22(35):7908-25. doi: 10.3748/wjg.v22.i35.7908.

    PubMed 27672287
  • Tan TC, Crawford DH, Franklin ME, Jaskowski LA, Macdonald GA, Jonsson JR, Watson MJ, Taylor PJ, Fletcher LM. The serum hepcidin:ferritin ratio is a potential biomarker for cirrhosis. Liver Int. 2012 Oct;32(9):1391-9. doi: 10.1111/j.1478-3231.2012.02828.x. Epub 2012 Jun 7.

    PubMed 22676252
  • Gkamprela E, Deutsch M, Pectasides D. Iron deficiency anemia in chronic liver disease: etiopathogenesis, diagnosis and treatment. Ann Gastroenterol. 2017;30(4):405-413. doi: 10.20524/aog.2017.0152. Epub 2017 May 3.

    PubMed 28655976
  • Alexopoulou A, Vasilieva L, Kanellopoulou T, Pouriki S, Soultati A, Dourakis SP. Presence of spur cells as a highly predictive factor of mortality in patients with cirrhosis. J Gastroenterol Hepatol. 2014 Apr;29(4):830-4. doi: 10.1111/jgh.12473.

    PubMed 24325340
  • Paternostro R, Kapzan L, Mandorfer M, Schwarzer R, Benedikt S, Viveiros A, Bauer D, Ferlitsch M, Zoller H, Trauner M, Ferlitsch A. Anemia and iron deficiency in compensated and decompensated cirrhosis: Prevalence and impact on clinical outcomes. J Gastroenterol Hepatol. 2020 Sep;35(9):1619-1627. doi: 10.1111/jgh.14988. Epub 2020 Feb 26.

    PubMed 31972057
  • Intragumtornchai T, Rojnukkarin P, Swasdikul D, Israsena S. The role of serum ferritin in the diagnosis of iron deficiency anaemia in patients with liver cirrhosis. J Intern Med. 1998 Mar;243(3):233-41. doi: 10.1046/j.1365-2796.1998.00290.x.

    PubMed 9627161
  • Vassiliadis T, Mpoumponaris A, Vakalopoulou S, Giouleme O, Gkissakis D, Grammatikos N, Soufleris K, Kakafika A, Tziomalos K, Patsiaoura K, Papanikolaou V, Evgenidis N. Spur cells and spur cell anemia in hospitalized patients with advanced liver disease: Incidence and correlation with disease severity and survival. Hepatol Res. 2010 Feb;40(2):161-70. doi: 10.1111/j.1872-034X.2009.00590.x. Epub 2010 Jan 11.

    PubMed 20070401
  • Liangpunsakul S, Ulmer BJ, Chalasani N. Predictors and implications of severe hypersplenism in patients with cirrhosis. Am J Med Sci. 2003 Sep;326(3):111-6. doi: 10.1097/00000441-200309000-00001.

    PubMed 14501224
  • Simbrunner B, Beer A, Woran K, Schmitz F, Primas C, Wewalka M, Pinter M, Dolak W, Scheiner B, Puespoek A, Trauner M, Oberhuber G, Mandorfer M, Reiberger T. Portal hypertensive gastropathy is associated with iron deficiency anemia. Wien Klin Wochenschr. 2020 Jan;132(1-2):1-11. doi: 10.1007/s00508-019-01593-w. Epub 2020 Jan 7.

    PubMed 31912289
  • Bothou C, Ruschenbaum S, Kubesch A, Quenstedt L, Schwarzkopf K, Welsch C, Zeuzem S, Welzel TM, Lange CM. Anemia and Systemic Inflammation Rather than Arterial Circulatory Dysfunction Predict Decompensation of Liver Cirrhosis. J Clin Med. 2020 Apr 26;9(5):1263. doi: 10.3390/jcm9051263.

    PubMed 32357568

Questions about this trial

What is this clinical trial studying?

An observational study of Anemia and Chronic Liver Disease, run by Post Graduate Institute of Medical Education and Research, Chandigarh at 1 site in India.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 10 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 28 Sep 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in India. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Madhumita Premkumar, MD, DM (+9101722756344, drmadhumitap1@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Etiologies of anemia in patients with liver disease (time frame: 1 month). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04622449, which also lists 14 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Sep 2021.

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